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2017 Vol. 23, No. 11
Published: 2017-11-25
 
961 Study of Predisposing Factors of Postoperative Axial Symptom after Unilateral Expansive laminoplasty for Treating Ossification of Cervical Posterior Longitudinal Ligament
Gong Teng 1，2，Su Xuetao 1，Xia Qun 1，et al

Objective  To investigate features，pathological mechanism and correlated risk factors of postoperative axial symptom (PAS) in multilevel ossification of cervical posterior longitudinal ligament(MOPLL) patients underwent unilateral expansive laminoplasty.Methods  79 patients with no less than 4 segments of MOPLL were treated by unilateral expansive laminoplasty and fixed with continuous miniplate fixation of open side.Preoperative and postoperative corrected value of inter-vertebral range of flexion and extension motion located in over all C2～7，C3～4 and C5～6 segments as well as postoperative alteration amplitude of straight core distance from C2 to C7 vertebrae and maximum gap distance of facet joints within operated domain were recorded.The data were retrospectively analyzed in our department.12 cases had PAS after surgery.The imaging parameters were compared between PAS group and nonPAS group.Results  Decrease extent of C2～7 movement in midsagittal plane in PAS group was higher than that in nonPAS group (P＜0.05).Preoperative range of C5～6 intervertebral motion in PAS group was larger than that in non-PAS group (P＜0.05).Loss degree of postoperative range of C3～4 sagittal motion in PAS group was more than that in non-PAS group (P＜0.05).Postoperative modification value of vertical core distance from C2 to C7 vertebrae and longest gap distance of lateral mass joints showed no difference between PAS and non-PAS group (P＞0.05).Conclusion  The preliminary study suggests that MOPLL patients with preoperative short-segment cervical instability will more likely have imbalance of intervertebral motion range and dynamic unsteadiness of stress distribution of soft tissues nearby，which induces PAS.
2017 Vol. 23 (11): 961-965 [Abstract] ( 313 ) HTML (1 KB)  PDF (1734 KB)  ( 294 )
966 The Clinical Study of Intradiscal Cement Leakage after Percutaneous Kyphoplasty
Lu Haibo，Liu Liqun，Wu Changming，et al
Objective  To study the effect of intradiscal cement leakage on the degeneration of cement-leaking discs and the interim clinical efficacy after percutaneous kyphoplasty (PKP).Methods  We retrospectively analyzed 188 cases of patients from March 2009 to September 2014 with the admittance to Liaoyang Central Hospital，diagnosed as thoracolumbar  vertebral compression fractures，including 32 males and 156 females with average age of 69.1 years (range，62～78 years).All were treated by PKP，classified into 26 cases with intradiscal cement leakage (Study Group) and 162 cases without cement leakage (control group).All cases were followed with an average of 25.2 months.The degeneration of discs was assessed using anterior disc height and posterior disc height on standard lateral radiographs.Clinical efficacy was assessed using the Oswestry Disability Index scores(ODI) and Visual Analog Scale(VAS).The changes of disc height and the ODI and VAS score were compared between the two groups.Results  Anterior disc height and posterior disc height of Study Group at the last follow-up：(5.65±2.21)mm、(2.94±0.89)mm；Those of control group：(7.36±2.43)mm、(3.77±1.84)mm.The disc height of the study group was significantly lower than the control group(P＜0.05).The ODI and VAS score of two groups before surgery：(72.98±12.42)％、(7.50±1.05)；(69.13±13.05)％、(7.44±0.97).The ODI and VAS score of two groups one day after surgery：(26.80±4.75)％、(2.45±0.63)；(25.95±5.07)％、(2.47±0.77).The ODI and VAS score of two groups at the last follow-up：(31.12±3.58)％、(2.81±0.72)；(29.75±4.32)％、(2.76±0.70).The ODI and VAS score of two groups were significantly improved after operation and continued to the last follow-up，and there was no significant difference between the two groups (P＞0.05).Conclusion  Intradiscal cement leakage can accelerate the degeneration of the intervertebral disc，but it does not affect the interim clinical efficacy after PKP.
2017 Vol. 23 (11): 966-969 [Abstract] ( 304 ) HTML (1 KB)  PDF (1704 KB)  ( 237 )
970 Analysis of the Change of Radiographic Parameters and Influential Factorsof Clinical Outcome after L4～5 Fusion Surgery
Wang Zhaoning，Zheng Lifeng，Chen Yan，et al
Objective  To explore changes of sagittal parameters and clinical outcome after L4～5 single segment fusion，and to analyze the influencing factors of clinical efficacy.Methods  46 patients (29 men and 17 women) who had complete followup date and received transforaminal lumbar interbody fusion (TLIF) of L4～5single segment in our hospital between January 2010 and January 2011 were enrolled in the study.The average age were (52.3±11.0) and the mean follow-up was (39.2±11.1)months(25～58 months) .The pain status of the lower limbs and the lower back pain were assessed by visual analogue scale (VAS)，the functional status was assessed by the Oswestry Dysfunction Index (ODI)，and sagittal parameters were measured using standing fulllength lateral radiographs before surgery，at the third month after surgery and final follow up respectively.The relationship between clinical efficacy and sagittal parameters was analyzed.Results  The VAS scores of lower limbs and low back pain and the ODI scores were all lower at the third month after operation and the last follow-up than those before operation and the differences were statistically significant (P＜0.05).There were no statistically significant differences for thoracic kyphosis (TK) and pelvic incident (PI) at 3 months and the last follow-up compared with those before surgery.The lumbar lordosis (LL)，sacral slope (SS)，PI-LL，L4～5 intervertebral height and intervertebral angle were significantly higher at the third month after surgery than those before operation and the differences were statistically significant (P＜0.05).At the last follow-up，LL，L4～5 intervertebral height and intervertebral angle were significantly higher than those before operation，PT and PI-LL were less than preoperative，and the differences were statistically significant (P＜0.05).Logistic regression analysis showed that LL，SS，L4～5 intervertebral height and intervertebral angle were the factors that affected the clinical efficacy.Clinical results were better in patients with greater LL，SS，L4～5 intervertebral height and intervertebral angle.Conclusion  TLIF of L4～5 single segment can achieve good clinical results and improve the sagittal alignment.LL，SS，L4～5 intervertebral height and intervertebral angle are important factors affecting clinical efficacy and should be fully considered in the development of surgical strategy.
2017 Vol. 23 (11): 970-974 [Abstract] ( 290 ) HTML (1 KB)  PDF (1461 KB)  ( 194 )
975 Clinical Study of Link Fixed Bearing Unicompartmental Knee Arthroplasty in the Treatment of Single Compartment Osteoarthritis of the Knee
Lu Mingfeng，Zhong Lubin，Yin Zhihao，et al

Objective  To investigate the clinical efficacy of Link fixed-bearingunicompartmental knee arthroplasty(UKA) in the treatment of medial knee osteoarthritis  (KOA). Methods  We choose 55 patients who had Link fixed-bearing unicompartmental knee arthroplasty from March 2014 to May 2016 in Guangdong Provincial Hospital of Traditional Chinese Medicine，including 25 males (25 knees) and 30 females (30 knees).The average age was 67 (53～81).The average weight was 64kg (45～83 kg). The patients were followed up for 12～26 months with an average of 15.6 months.All cases completed by the same surgeon，using a fixed platform Link unicompartmental prosthesis system line medial condyle replacement，and minimally invasiving UKA take small incision technique.The patients were collected for statistical analysis of the operation time，blood loss，postoperative hospital stay，hospitalization costs and other data.To observe the occurrence of postoperative complications after UKA surgery.Before and after surgery，the anterior lateral knee joint X-ray and full-length negative double-arm X-ray were performed.The preoperative and postoperative femorotibial angle (FTA)，hip-knee-ankle angle (HKA) and range of motion (ROM) of the knee joint were measured. And at the time of the last follow-up，the hospital's special surgery knee score (HSS score)，the American Knee Association score were evaluation.Data were processed and statistically analyzed using SPSS 18.0 software (P＜0.05 was considered statistically significant).Results  The average operation time of 55 patients (55 knees) was 89.36 min.The mean intraoperative blood loss was 50.71 mL.The average length of postoperative hospital stay was 7.5 days and the average cost of hospitalization was 37 768.5 yuan.All patients underwent surgical resection with grade A healing without infection.Perioperative complications such as pulmonary embolism，deep venous thrombosis of lower extremities，iatrogenic neurovascular injury and periprosthetic fracture occurred.Average follow-up 15.6 months (12～26 months)，patients with quality of life was significantly improved compared with preoperative，all cases were no sterile prostheses loosening，unexplained pain，polyethylene liner dislocation and other complications.The preoperative HKA was (173.6±3.5)° and postoperatively(177.5±1.4)°.The average preoperative FTA was (180.5±4.2)° and the average postoperative period  was (175.4 ± 5.8)°.The maximal knee joint activity increased from preoperative (94.5±8.1)° to postoperative (113.7±7.8)°.The above data，preoperative and postoperative compared，the differences were statistically significant (P <0.05).KSS functional scores were (58.7±7.8)° and (86.4±6.8)° .The HSS scores of knee joint at preoperative and final follow-up were respectively(46.5±5.8)° and (85.7±8.7)°.Compared the data from last follow-up with that before surgery，there were statistically difference in the three groups(P＜0.05).Conclusion  Unicompartmental arthroplasty with link Sled fixed-bearing single condylar prosthesis and minimally invasive single condylar technique is a good option for patients with osteoarthritis of the medial compartment of the knee.The reseans includ small trauma，less bone resection，shorter operation time，less blood loss，shorter postoperative hospitalization time，less complication，quicker postoperative recovery ，greater joint activity，better body feelings and so on.The short-term effect is satisfactory，the alignment of lower limbs is improved obviously，and its long term effect needs further observation.
2017 Vol. 23 (11): 975-990 [Abstract] ( 375 ) HTML (1 KB)  PDF (1148 KB)  ( 309 )
980 Shoulder Dysfunction Complications in Patients with Hand Injury and The Treatments Strategy
Guo Jin，Zhu Cheng，Fan Xiaobin，et al
Objective  To investigate the reasonsof shoulder dysfunctioncomplications developed in patients with hand injury and the treatments for these patients.Methods  167 patients were included in this study and received rehabilitation therapy in our department from 2014 to 2016.Among the patients.128 of them were male and 39 were female.The age range from 20 to 58 with an average of 34.3.The patientswho had a history of shoulder injury were excluded.Considering the time and the type of the developed shoulder dysfunctioncomplications by reviewingthe patients' medical history，the patients were divided into three groups according to the time point for starting the rehabilitation therapy.Results  43 patients (25.75％) developed shoulder dysfunctioncomplications 4～8 weeks after they had the hand injury.The mean age of the patients with shoulder complications was 34.81 years，roughly equal to the average age of the patient without shoulder dysfunctioncomplications.And the difference was not statistically significant by the chi-square test.The optimal rate of improvement of shoulder joint function was 100％ in the group of 3 months after the system rehabilitation training.Inthe 3～6 months of rehabilitation training group，the optimal rate was 95.8％.Inthe 6～12 months of rehabilitation training group，the optimal rate was 27.3％.Conclusion  As compared the patients who take the therapy 6 months after hand injury，the shoulder complication significantly relieved in patients who received the therapy in 3 month after injury.Early rehabilitation therapy can significantly reduce the chance of shoulder dysfunction complication developed in patients with hand injury.
2017 Vol. 23 (11): 980-982 [Abstract] ( 305 ) HTML (1 KB)  PDF (399 KB)  ( 254 )
983 Modified Vertical Wire Technique for the Treatment of the Patellar Distal Pole Fracture
He Shuangjian 1，2，Huang Xiaoyi 2，Yan Bin 2，et al
Objective  To investigate the clinical outcome of the modified vertical wire technique for the treatment of distal pole fracture of the patella.Methods  A three-dimensional model of modified vertical wire for inferior pole fracture of the patella was established and then the biomechanical property of the modified technique was analyzed by finite element method.From March 2013 to January 2016，15 consecutive patients with distal pole fractures of the patella treated with modified independent vertical wire technique were enrolled in this study and then the operative parameters regarding operational time as well as incision length，postoperative complications and functional outcomes were assessed.Results   In the clinical study，12 of 15 patients were followed up for 13～35 months，the mean follow-up period was (21.08±6.81)months and the mean incision length and operation time was(7.75±1.81) cm (6～12 cm) and (42.50±12.80) minutes (range，23～60 minutes).Incision infection，implant breakage，nonunion，and loss of reduction did not occur.One patient suffered loosening of the twisted knot of the cerclage wire at 8 months after operation.At the final follow-up，the mean Bostman score was (29.16±0.834) (28～30) and the average range of the knee motion arc was (131.25±3.1)°(125°～135°).Conclusion  The modified independent vertical wire technique for the treatment of distal fracture of the patella is an effective，simple and minimally invasive surgery which can provide stable fixation for immediate postoperative extension and flexion exercise and early full weightbearing with lower cost of treatment and ultimately excellent functional results.
2017 Vol. 23 (11): 983-1003 [Abstract] ( 279 ) HTML (1 KB)  PDF (1194 KB)  ( 252 )
986 Subtalar Joint-preserving Osteotomy for Calcaneal Malunion
Zhang Hongning，Zhu Yongzhan，Zhou Yunxuan，et al
Objective  To discuss results of treating calcaneal fracture malunion by reserving or restoring the subtalar joint with calcaneal osteotomy.Methods  From January 2014 to February 2016，20 patients(21 feet) with the mean time from initial injury to reconstructive operation of 3～11(5±2.5)months were treated by oblique osteotomy at the calcaneal body which gained the correction by traslation of calcaneal tuber，and a new the intra-articular osteotomy to restor subtalar joint using excisinal lateral wall grafting.The incisions were closed at one stage in 20 cases，and the flap was used to cover the wound in 1 case.19 feet in 19 patients were follow-up for (11±1.5)months(12～18 months)except for 1 patients losing follow-up after 3 months after operation.The clinical effect were evaluated by clinical outcomes and radiographical result.Results  Four(21.1％) of nineteen feet had delayed wound healing with no deep infection.All of patients achieved initial union at 10～12 weeks，in which 6 cases had different degrees of residual pain at the lateral aspect of the ankle.The postoperative Maryland foot score was significantly higher and the B-hler’s angle，Gissane’s angle，talus declination angle，and width and height of calcaneus were improved greatly than the preoperative assessment and the difference was statistically significant.Conclusion  Reserving or restoring the subtalar joint with calcaneal osteotomy can regain the calcaneal shape and biomechanical mechanism，and achive good clinical effect in treating calcaneal malunion with normal or most normal articular cartilage in the subtalar joint.
2017 Vol. 23 (11): 986-990 [Abstract] ( 444 ) HTML (1 KB)  PDF (1654 KB)  ( 308 )
991 Time Course of Perioperative Deep Venous Thrombosis of Lower Extremity Limb in Osteoporotic Hip Fracture in Senile Patients
Wei Junqiang 1，Sun Hao 1，Liu Lirui 2，et al
Objective  To study the temporal pattern of deep venous thrombosis of the lower limb in patients with perioperative hip fractures，and to provide the basis for the prevention of clinical thrombosis.Methods  From June 2013 to June 2016，398 cases of femoral fractures (178 cases of femoral neck fractures and 220 cases of intertrochanteric fractures) were divided into anticoagulant group and non-anticoagulation group according to the different anticoagulation time.The patients with hip fractures treated by traumatic orthopedic surgery in Chengde Medical College Hospital All patients were treated with lower extremity venous Doppler ultrasonography on the 1st，3rd，5th day after injury，more than 5 days after injury and on the 2nd，5th，7th and 14th day after operation.The time of thrombosis and the different groups Number of thrombosis cases.The number of new cases of thrombosis and the incidence rate were analyzed statistically at different time points.The frequency distribution curve was used to analyze the peak time of perioperative thrombosis.Results  398 cases were taken in the study.The LMWH prophylaxis thrombosis before operation group were 226 cases，24 cases were diagnosed as deep vein thrombosis(DVT)，and the incidence was 10.61％.The non-LMWH prophylaxis thrombosis before operation group had 172 cases，and 37 cases were diagnosed deep vein thrombosis (DVT)，and the incidence was 21.5％.The difference between two group was significant.The numbers of the LMWH prophylaxis thrombosis before operation group of the DVT at the first day after trauma，the third day，the fifth day and more than the fifth day after trauma.，the second day，the fifth day，the seventh day，the fourteenth day post-operative were 2(0.88％)、6(2.65％)、3(1.33％)、2(0.88％)、9(3.98％)、2(0.88％)、0(0％)、0(0％) respectively.The numbers of the non-LMWH prophylaxis thrombosis before operation group of the DVT at the first day after trauma，the third day，the fifth day and more than the fifth day after trauma，the second day，the fifth day，the seventh day，the fourteenth day  post-operative were were3(1.74％)、9(5.23％)、3(1.74％)、4(2.33％)、11(6.40％)、4(2.33％)、1(0.58％)、2(1.16％)respectively，the incidence of DVT at the first three day after injury and the first day after operation were hightest.Conclusion  In hip fractures patients，thrombosis occurred within 3 days after injury and one day after surgery.Timely application of drug prevention can reduce the perioperative fractures of patients with perioperative lower extremity venous thrombosis rate.
2017 Vol. 23 (11): 991-999 [Abstract] ( 268 ) HTML (1 KB)  PDF (515 KB)  ( 270 )
995 Expression and Function of miR-140 in Different Stage Chondrocytes of Patients with Osteoarthritis
Li Canfeng 1，Chen Zhuo 2，Yang Jing 1，et al
Objective  To investigate the expression miR-140 in different stage of osteoarthritis and its function after transfecting ds-miR-140 mimic/inhibitor into chondrocytes. Methods  Cartilage was classified into three groups，normal group，mid-staged group and advanced-staged group，according to the Kellgren and Lawrence criterion.6-8 cases of normal or OA cartilage were collected and chondrocytes were isolated.The second generation of chondrocytes were used to test.The levels of miR-140，COL2A1 and COL10A1 mRNA were measured with real-time fluorescent quantitative PCR.The ds-miR-140 mimic/inhibitorwere transfected into the mid-staged group，and the expression of COL2A1，COL10A1 and SOX9 were measured.Results  Compared with the normal group，miR-140 expression in the mid- and advanced-staged group was decreased by 34.1％ and 49.3％ respectively，and its expression in advanced-staged group was decreased by 73.9％.Beside，SOX9 expression in the mid- and advanced-staged group was decreased by 75％ and 82.7％respectively，COL2A1 expression decreased by 36.7％ and 78.7％ respectively，while COL10A1 expression increased to 1.66 times and 2.10 times respectively.After transfecting ds-miR-140 mimic/inhibitor into the mid-staged group，SOX9 expression was increased by 1.95 times or decreased by 59.1％，COL2A1 expression was increased by 1.87 times or decreased by 68.8％，and COL10A1 expression was decreased by 73.0％ or increased by 1.96 times.Conclusion  The expression level of miR-140 decreased in osteoarthritic chondrocytes and was negatively related to the severity of OA.Overexpression its level by transfecting ds-miR-140 mimic into chondrocytes could up-regulate SOX9 and COL-2A1 expression while down-regulate COL10A1 expression.
2017 Vol. 23 (11): 995-999 [Abstract] ( 247 ) HTML (1 KB)  PDF (480 KB)  ( 347 )
1004 Anterior Tibal Fibular Ligament Reconstruction with Semi peroneus Brevis in Treatment of Chronic Ankle Instability
Deng Jinjing，Sun Tianxiang，Zhong Yilin
Objective  To investigate early clinic effect of chronic lateral ankle instability with Semi-peroneus brevis anatomic reconstruction.Methods  From July 2013 to August 2014 25 patients with chronic lateral instability of ankle were reviewed.There were 13 males and 12 females with an average age of 30.5 years (25 to 54 years).Karlsson scores and AOFAS scores system were used to evaluate clinic effect in last follow-up.Results  All the patients had successful surgery of anterior tibal fibular ligament reconstruction.There was no infection.All the patient were followed up.The duration ranged from 13 to 29 months，with an average of (19.5±3.7) months.All the patients went back to former work.Karlsson scores and AOFAS scores improve significantlycompared with those beforesurgery. Conclusion  Anterior tibal fibular ligament rescontrucion with semi-peroneus brevis can effectively treat chronic lateral instabiltywith advantage of mini-trauma，easy-procedure，satisfactory-ankle function.
2017 Vol. 23 (11): 1004-1006 [Abstract] ( 281 ) HTML (1 KB)  PDF (761 KB)  ( 291 )
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